Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain
and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is
characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago,
intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is
retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain
is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular.
Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses
would be most likely?
Question 4 options:
a)
Musculoskeletal chest wall syndrome with radiation
b)
Esophageal motor disorder with radiation
c)
Acute cholecystitis with cholelithiasis
,d)
Coronary artery disease with angina pectoris
Question 2 (2 points)
Which disease process typically causes episodic right upper quadrant pain, epigastric pain or
chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right
shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty
meal.
Question 5 options:
a)
Acute pancreatitis
b)
Duodenal ulcer
c)
Biliary colic
d)
Cholecystitis
, Question 3 (2 points)
Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric
ulcers. What teaching should the nurse practitioner plan for a patient who has a
positive Helicobacter pylori test?
Question 6 options:
a)
It is highly contagious and a mask should be worn at home.
b)
Treatment regimen is multiple lifetime medications.
c)
Treatment regimen is multiple medications taken daily for a few weeks.
d)
Treatment regimen is complicated and is not indicated unless the patient is symptomatic.
Question 4 (2 points)
An obese middle-aged client presents with a month of nonproductive irritating cough without
fever. He also reports occasional morning hoarseness. What should the differential include?
Question 7 options:
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